Evaluation of a National Quality Improvement Collaborative for Improving Cancer Screening
Authors: Rachel Hae-Soo Joung, Timothy W. Mullett, Scott H. Kurtzman, Sarah Shafir, James B. Harris, Katharine A. Yao, Karl Y. Bilimoria, William G. Cance, Heidi Nelson, Ali Abedi, Sheetal Acharya, Karen T. Adams, Rishi Agarwal, Sachin Agarwal, Rima Ahmad, Philip Albaneze, Kimberly Aldis, Ahkeel Allen, Shayla Allman, Meiling Alsen, Mindy Ansteth, Angela A. Appiah, Candy Arentz, Amanda (Lori) Arias, Christine Armetta, Alicia H. Arnold, Camelia Arsene, Karen Arthur, Brandon Ashton, M Bassel Atassi, Sameh Attia, Heidi Bahna, Laurence Bailen, Thelma Baker, Stefan Balan, Amy Balis, Anne Balsley, Denise Barajas, Julie L. Barone, Brett Batchelor, Elizabeth Bates, Trevor Bayliss, Susan Beck, Brandon Bennett, Ryan Bennett, Nathan Bennett, Jessica Bensenhaver, Jane Berby-Todd, Julian Berrocal, Danielle Bertoni, Alison Bevan, Rabia Bhatti, Carol Bier-Laning, Margaret M. Blackwood, Kenneth Blake, Joanna G. Blankner, Joseph A. Blansfield, Lawrence Blaszkowsky, Brian Blonigen, David Bloom, Justin Boatsman, Jonathan Boggs, Richard Bold, Deborah Bollinger, Cheryl Bolton, Susan Boolbol, Greg Boone, Lawrence Borges, Michael Bouton, Carol L. Bovest, Tara Bowman Seitz, Carol Boyer, Colton Boyle, Francisco A. Bracho, Autumn Bragg, Susan Branton, Tara M. Breslin, Melissa N. Brock, Arkady Broder, Christine Brown, Bradley Brown, Holly Brown, Lisa M. Brown, Richard Brown, Laura Bruce, Sara Bruce, Catherine Bruton, Karen Bryant, William Burak, Jessica Burgers, Kristin Busch, David Caba, James Cain, Matthew Campbell, Cynthia Campo, Lynn Canavan, Leander Cannick, Paula Caputo, H. Janelle Carr, Christina Casteel, Stephen Cattaneo, Austin Cecil, Paul Celano, Karinn Chambers, Stella Chambers, Janet Chin, M Kathleen Christian, Crystal Chu, Allison Church, Jamie Clark, Lynne P. Clark, Marsha Clements, Seth Cohen, Cathy J F Cole, Danielle Colemire, Julia Compton, Cliff P. Connery, Delia Constanza-Guaqueta, Stacey Contreras, Alan B. Coon, Kathleen L. Copelen, Javier Corral, Rosa Cosio, Kimberly E. Costas, April Cox, John A. Cox, Erin P. Crane, David Crotzer, Celeste G. Cruz, Angelique Cygan, Lisa Cyphers, Cheryl Czerlanis, Paul S. Dale, Shivang Danak, Pragya A. Dang, Jorge G. Darcourt, Raj Davuluri, Barbara Day, Phyllis DeAntonio, Yamile Der, Nelah DiAddezio, Leah L. Dietrich, Edma Diller, Tanya Dodge, Gabriel Domenech, Diana Donovan, Elizabeth Dubil, Gary Dunn, Lindsay Ebling, Bonnie Edsall, Bogdan Eftimie, Nemer J. El Mouallem, Firas Eladoumikdachi, Joy Elliott, Katie Elliott, Melissa Ellis, Kenneth Endo, Trisha England, Carrie Ennis, Toni Everhart, Amy Evins, Matthew A. Facktor, Celine Fadel, Michael Farrell, Diane Fawley, Elizabeth D. Feldman, Michael A. Finan, Andrew Fintel, James Fleshman, Sara P. Fogarty, Hiral Fontanilla, Eric C. Fontenot, Jon Foran, Chaundra Foss-Blizard, James Frank, Julie Franz, Lu Freeman, Rolf Freter, Steven Fried, Ryan Gabriel, Joan Galbraith, Johanny Garcia, Kim Gardner, Karen Geary, David J. Gemmel, Jessica Gerlach, Lauren Ghee, Maurizio Ghisoli, Deborah Giannone, Courtney Gibbons, Paul Gillis, Denis Gilmore, Victor J Gonzalez, Leann Gooley, Christine Gorrell, Sally Grady, David Grew, Shaunda Grisby, Carmen E. Guerra, Jacqueline Guerriero, Kunal Gupta, Michael Gynn, Laura Hafertepen, Christy Hale, Ryan Hallenbeck, Ladonna Hals, Emmy L. Hammons, Linda B. Haramati, Natalie W. Harper, James Harris, Meredith A. Harrison, Miranda Harrison, John Hassapis, Betty Haverlock, Aimee Hawley, Theresa Hayden, Cherylle Hayes, Dawn M. Hayes, Carole Headen, Erika Hehnly, Sarah Heikens, Stephen Heinzman, Mary E. Herring, Michelle Hill, Patricia Hirner, Kiera Hobbs, Heidi Hordyk, Neil Horning, Donna Howard, Kan Huang, Corilynn Hughes, Jenevieve Hughes, Carol Huibregtse, Nancy Huitt, Laura Hunsucker, Tina Inverso, Tonia Irwin, Melanie Isbell, Nicola Jabbour, Mia L. Jackson, Raymond Jackson, Sherly Jacob-Perez, Nazia Jafri, Salik Jahania, Adam Jarrett, Scott Jenkinson, Richard Johnson, Anna Johnson, Dianne Johnson, Patricia Johnson, Catherine Johnston, Roberta Jones, Susan Jones, Joyce Joseph, Natalie E. Joseph, Robert L. Joyner, Maria Juarez-Perez, Kimberly Kaczmarski, Vijaya Kakani, Amir Kamran, Samer Kanaan, Tyler Kang, Joseph Kannarkatt, Shalini R. Kanneganti, Belagodu Kantharaj, Howard Kaufman, Vickie Keeler, Shanna Keiser, Malissa Kennedy, Iftekhar Khan, Raza Khan, Lesley P. Kibel, Marianne Kiernan, Brian Kim, Adriene Kinnaird, Kristen L. Kipping-Johnson, Peggy Kirkland, Sandeep Kirshnan, Lindy Klaff, Robert Kloss, Jeffrey K. Klotz, Susan Knight, Julie Koch, Paul G. Kocheril, Dhatri Kodali, Manpreet Kohli, Isoken Koko, Amanda L. Kong, Olga Kozyreva, Lorei A. Kraft, Stacy Krisher, Edward J. Kruse, Amanda Kupstas, Mini Kurian, Rebecca Kwait, Cynthia Lan, Rachelle Lanciano, Wendy Lannon, Sydney R. Laster, Linda R. LaTrenta, Suzanne A. Law, Isabelle Le, Nancy Lean, Keith Leatherbury, Jacqueline Lee, Tyler Leete, Mary Legenza, Winifred K. Leung, Jongming Li, Anna Likhacheva, Brian Lingerfelt, Omar H. Llaguna, Laura Longo, Melissa Loop, Nicholas Lopez, Nancy Loporchio, Jennifer Lowney, Carisa Lozoraitis, Kit Y. Lu, Deborah Lue, Richard Lush, David T. Luyimbazi, Debra Lyons, Francisco I. Macedo, Michelle Machenzie, David Mack, Julie Mack, Jessica MacVicar, Kathleen L. Mah, Kathryn Mahoney, Neeharika S. Makani, Della Makower, Salman Malad, Cynthia Maldonado, Farhana Malik, Angie Malone, Suparna Mantha, Kristina Marczak, Nathaniel Margolis, Kathleen Mashanic, Jill Mathison, Tiffany Mauzy, Leslie Maxwell, Jennifer McAllaster, Caitlin McCarthy, Jason McClune, Jennifer K. McColgan, Teresa McCusker, Dana McDaniel, Lynette McFayden, Randall McGivney, Kerri McGovern, Hannah McKeever, Susan McManus, Kate McNair, Heather McNeil, Jennifer McRae, Consuelito A. Medrano, Pallav Mehta, Tricia Merrigan, Eva Meyers, Suzanne Mickey, Jackie Miller, Luke Miller, Stephanie Miller, Tara Mink, Jodi Miranda, Mary M. Mitchell, Julie Monroe, Joyce Moore, Garnetta Morin-Ducote, Troy Moritz, Paul T. Morris, Sumit Mukherjee, Sean D. Mullally, Margaret Mulligan, David A. Mullins, Mary Mullins, Ivonne Munoz, Jeremy J. Murdock, Stacie N. Myers, Sindhu Nair, Kiran Nandamuri, Joanne Nicholls, Donna Nick, Andrew Nish, Andrew Nowell, Kerri Nowell, Lynn M. O'Connor, Judy O'Neill, Moira O'Riordan, Roselyn Ogunkunle, Margo M. Opsasnick, Cindy A. Ortiz, Rebecca Osgood, Jacqueline Oxenberg, Brandi R. Page, Jacquelyn A.V. Palmer, Dhaval K Parikh, David J. Park, Jessica Partin, Chelsea Passwater, Mita Patel, Jilma Patrick, Shauntee Patterson, Laura Pearson, Susan Peiffer, Elizabeth Peralta, Mary Peterson, Benjamin Pettus, John Pezzulo, Megan Pfarr, Connie Phelps, Lacy Phillips, Matthew Pick, James Piephoff, Jodee Pinkston, Jessica Piper, Stanley B. Pollak, Robert Ponec, Muhammad J. Popalzai, Susan E. Pories, Robert Prieto, Kerry Proctor, Karla Provost, Debra Prow, Matthew Puc, Mary Purdon, Brian P. Quaranta, Sean Quinlan-Davidson, Alfredo Rabines, Rakhshanda L. Rahman, Rashmi Ramasubbaiah, Maricarmen Ramírez-Solá, David Randolph, Elizabeth R. Raskin, Linda Rasmussen, Nicole Rasmussen, Ronald Rasmussen, Clinta C. Reed, Shellee Reese, Shawn M. Regis, James Reilly, Richard Reitherman, Curtis Reneau, Connie Renfroe, Carol Renn, Chantal Reyna, Kimberly Rieger-Christ, Rochelle Ringer, Tina Rizack, Uzma Rizwan, William R. Robinson, Evelyn Robles-Rodriguez, Ethan S. Rogers, Melissa Ronk, George Rossidis, Marc A. Rovito, Abhik Roy, Lisa Roybal, George Ruggiero, Rachel Ruskin, Jessica Ryan, Kush Sachdeva, Anne Saffie, Noura Sall, Dana Salters, Juan F. Sanchez, Joy Sandborn, Michael D. Sarap, Michael Sarap, Jennifer Sasaki, John M. Schallenkamp, Lawrence E. Schilder, Kimberly W. Schlesinger, Jackie Scholl, Michael Scoppetuolo, Jeanie Scott, Will Sexton, Anna Seydel, Mazin Shackour, Apurva Shah, Minal Shah, Suhail Sharif, Camilla M. Shaw, Andrew Shehata, Charles H Shelton, Reve Shields, Sabrina Shilad, Eugene Shively, Michelle Shriner, Joel R. Siebentritt, Shyamali Singhal, Shreya Sinha, Suman Sinha, Jaime Slotkin, Kaylene Smith, Sarah Smith, Stephanie Smith-Marrone, Lawrence D. Sobel, Anna Sobolewski, Robin Sobolewski, Naveenraj Solomon, Tonya C. Songy, Fran Sonnier, Leslie Sorenson, Juan C. Sorto, Will Souza, David M. Spector, Zachary Spigelman, Barbara Steitz, Clifford Stephens, Sheelagh Stewart, Gretchen Stipec, Brittany Stith, Holly Street, Janakiraman Subramanian, Maria Sumrall, Mark Sundermeyer, Ali Syed, Michael Szwerc, Laura Tanner, Tracey Tatum, Roxana Taveira, Michael Taylor, Julia Taylor, Christine B. Teal, Christina Tello-Skjerseth, Kenneth Terhaar, Margaret Terhar, Ravneet Thind, Kendra L. Thomas, Nancy Thompson, Carey C. Thomson, Brandon Tieu, Madhavi Toke, Megumi Tomita, Kenneth Tomkovich, Elisa Tong, Peter Tothy, Maria Tran, Kay Travis-Soper, Gaurav Trikha, Guarev Trikha, Raj Vasnani, Nirmal Veeramachaneni, Annabelle Veerapaneni, Deanna Ventura-Cullen, Dee Vester, Julia Vinsky, Anthony Visioni, Lindsay Vlaminck, Akhil Wadhera, Jamie Wagner, Brandy Waits, Sharon Walenga, Michael Walker, Lucy B. Wallace, James A. Wallace, Marie Ward, Kirsten Warmington, Richard Wasley, Kimberly L. Watson, Wendy Watson, Jonathan Waxman, Robert Weathersby, Elizabeth A. Weaver, Mary E. Weber, Christine Weiselberg, Cheryl Wesen, Ann Wexler, Darlene Weyer, Paul White, Christina White, Karolina Whitefield, Reagan Wilkinson, James C. Willey, Verneetta Williams, Jason P Wilson, Virginia M. Witt, Howard Wold, Deb Woodford, Scott Woomer, Justin W. Wray, Karen Yeh, Kahyun Yoon-Flannery, Richard Zera, Michael Zlomke, Kirby Zummo, Karen Zwicky
Journal: JAMA Network Open (2022)

Importance Cancer screening deficits during the first year of the COVID-19 pandemic were found to persist into 2021. Cancer-related deaths over the next decade are projected to increase if these deficits are not addressed. Objective To assess whether participation in a nationwide quality improvement (QI) collaborative, Return-to-Screening, was associated with restoration of cancer screening. Design, Setting, and Participants Accredited cancer programs electively enrolled in this QI study. Project-specific targets were established on the basis of differences in mean monthly screening test volumes (MTVs) between representative prepandemic (September 2019 and January 2020) and pandemic (September 2020 and January 2021) periods to restore prepandemic volumes and achieve a minimum of 10% increase in MTV. Local QI teams implemented evidence-based screening interventions from June to November 2021 (intervention period), iteratively adjusting interventions according to their MTVs and target. Interrupted time series analyses was used to identify the intervention effect. Data analysis was performed from January to April 2022. Exposures Collaborative QI support included provision of a Return-to-Screening plan-do-study-act protocol, evidence-based screening interventions, QI education, programmatic coordination, and calculation of screening deficits and targets. Main Outcomes and Measures The primary outcome was the proportion of QI projects reaching target MTV and counterfactual differences in the aggregate number of screening tests across time periods. Results Of 859 cancer screening QI projects (452 for breast cancer, 134 for colorectal cancer, 244 for lung cancer, and 29 for cervical cancer) conducted by 786 accredited cancer programs, 676 projects (79%) reached their target MTV. There were no hospital characteristics associated with increased likelihood of reaching target MTV except for disease site (lung vs breast, odds ratio, 2.8; 95% CI, 1.7 to 4.7). During the preintervention period (April to May 2021), there was a decrease in the mean MTV (slope, −13.1 tests per month; 95% CI, −23.1 to −3.2 tests per month). Interventions were associated with a significant immediate (slope, 101.0 tests per month; 95% CI, 49.1 to 153.0 tests per month) and sustained (slope, 36.3 tests per month; 95% CI, 5.3 to 67.3 tests per month) increase in MTVs relative to the preintervention trends. Additional screening tests were performed during the intervention period compared with the prepandemic period (170 748 tests), the pandemic period (210 450 tests), and the preintervention period (722 427 tests). Conclusions and Relevance In this QI study, participation in a national Return-to-Screening collaborative with a multifaceted QI intervention was associated with improvements in cancer screening. Future collaborative QI endeavors leveraging accreditation infrastructure may help address other gaps in cancer care.